Trigeminal Neuralgia
Trigeminal neuralgia or “tic douloureux”, is a relatively uncommon facial pain syndrome caused by dysfunction of the “trigeminal” or 5th cranial nerve. This nerve supplies sensation to the face and power to the chewing muscles of the jaw. The pain of trigeminal neuralgia is typically characterized by sudden, explosive bursts of knife-like, shooting pains involving one side of the face, usually from the cheek to the bottom of the jaw. The area around the eye is less commonly affected. Pain episodes may only last for several seconds to several minutes with long pain free periods in between. Attacks may also be triggered by light touch, pressure, or stroking of so-called “trigger zones” in the areas affected by pain, including speaking, tongue movements, or eating. Facial sensation is usually preserved, although mild sensory loss in painful areas may be rarely seen. The exact cause in unknown, although in about 70% o
f cases, compression of the main sensory branch of the nerve as it exits the brainstem can be demonstrated by special MRI scans or at surgery. Diagnosis is made based primarily on the typical symptoms listed above, and exclusion of other conditions such as brain tumors, dental disease, and other neurological diseases. Spontaneous remissions are common early in the course of the disease and medical management is appropriate initially. Carbamazepine, is the drug of choice and has been found to be effective in many patients. Other anti-epileptic drugs have also been found to be effective as initial medical treatment. If side effects occur or pain is unrelieved by an adequate trial of medication, interventional nerve block procedures, or surgery have proven very effective for the long term prevention of pain episodes. Interventional needle-based techniques include glycerol or radiofrequency trigeminal “rhizotemy” or nerve block. Surgical options include balloon compression, microvascular decompression, and most recently “gamma knife” radiosurgery. Most of the available treatments are highly effective initially, and appropriate for the treatment of individual patients. The primary difference between the various techniques is the operative risk to the patient, the probability of some loss of facial sensation, and the risk of pain recurrence over time. Both minimally invasive techniques of glycerol and radiofrequency trigeminal rhizotemy are available at the Foothills Regional Pain Center. Our staff physicians will be happy to discuss treatment options with patients suffering from trigeminal neuralgia to help decide which form of treatment is best.
More information can be obtained from the Trigeminal Neuralgia Association website at www.tna-support.org/
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
Copyright© Foothills Pain and Anesthesia
Site Design and Hosting